Reticulate Skin Lesions: Practical Color-Based Algorithm for Initial Clinical Assessment. / Lesiones cutáneas reticulares: algoritmo clínico práctico basado en el color de la lesión para el abordaje inicial.

Reticular patterns are observed in a great variety of skin diseases. While these morphologic patterns are often highly distinctive, they are seldom discussed or studied in clinical contexts or recognized as a diagnostic category in their own right. Diseases presenting with reticulate skin lesions have multiple etiologies (tumors, infections, vascular disorders, inflammatory conditions, and metabolic or genetic alterations) and can range from relatively benign conditions to life-threatening ones. We review a selection of these diseases and propose a clinical diagnostic algorithm based on predominant coloring and clinical features to aid in their initial assessment.

[Translated article] Reticulate Skin Lesions: Practical Color-Based Algorithm for Initial Clinical Assessment.

Reticular patterns are observed in a great variety of skin diseases. While these morphologic patterns are often highly distinctive, they are seldom discussed or studied in clinical contexts or recognized as a diagnostic category in their own right. Diseases presenting with reticulate skin lesions have multiple etiologies (tumors, infections, vascular disorders, inflammatory conditions, and metabolic or genetic alterations) and can range from relatively benign conditions to life-threatening ones. We review a selection of these diseases and propose a clinical diagnostic algorithm based on predominant coloring and clinical features to aid in their initial assessment.

Sintonizando con otro: la teoría polivagal y el proceso de psicoterapia / Tuning into another: the polivagal theory and the psychotherapy process

RESUMEN: El presente trabajo tiene como principal objetivo presentar la teoría polivagal como un modelo bio-comportamental del comportamiento emocional e interpersonal, con la finalidad de identificar ámbitos de contribución de la teoría al estudio de la psicoterapia en torno al estatus clínico de los consultantes, el proceso terapéutico y el cambio. La revisión del modelo neurofisiológico muestra una reconceptualización las relaciones recíprocas entre sistema nervioso autónomo y la emocionalidad en el contexto interpersonal, lo cual permite distinguir condiciones de activación normal y patológica de las estrategias comportamentales defensivas (lucha/huida e inmovilización), así como su inhibición a través del sistema de enganche prosocial. Las investigaciones revisadas muestran evidencia a favor de las hipótesis derivadas del modelo tanto en población normal como clínica. De particular interés clínico resulta el sistema de enganche prosocial, pues habilita la emergencia del comportamiento interpersonal confiable, lo cual resulta ser un elemento pivotal para la psicoterapia por su potencial valor diagnóstico, así como sus efectos sobre el desarrollo y consolidación de la relación terapéutica y los resultados benéficos en el consultante. Finalmente, es posible identificar un cuerpo emergente de estudios de psicoterapia que evalúan la actividad del sistema de enganche prosocial mediante la variabilidad de la frecuencia cardiaca de alta frecuencia, vinculándolo tanto al proceso (p. ej., alianza de trabajo) como al resultado (p. ej., nivel de síntomas), evidenciando el valor de profundizar en esta línea interdisciplinaria de investigación y, eventualmente, incorporar estas mediciones al arsenal clínico de evaluación.

ABSTRACT The present work presents the polivagal theory as a bio-behavioral model of emotional and interpersonal behavior, aiming to identify its theoretical contributions to the study of psychotherapy regarding client's clinical status, therapeutic process as well as change. A review of the model shows a reconceptualization of interactions among autononomic nervous system and emotionality within interpersonal context, allowing for identifying normal and pathological activation of defensive behavioral strategies (figh-or-flight and immobilization), as well as their inhibition through the social engagement system. Empirical research shows evidence in favor of hypotheses derived from the model in normal and clinical populations. In clinical contexts, the social engagement system is of particular interest as it allows the emergence of interpersonal trustworthy behavior, being a cornerstone in psychotherapy due to its potential diagnostic value for clients, the development of the therapeutic relationships, as well as beneficial outcomes. Lastly, a nascent body of psychotherapy studies assessing the social engagement system (through high frequency heart rate variability-) and its relation with the therapeutic process (i.e. working alliance) and outcomes (i.e. symptom level) are identified. The evidence supports the value of further developing this interdisciplinary line of research and, eventually, incorporating these measurements into the clinical assessment arsenal.

Mediastinitis necrotizante descendente de origen odontogénico / Descending necrotizing mediastinitis of odontogenic origin

Resumen Introducción: El tratamiento inoportuno e ineficaz de las infecciones odontogénicas puede causar complicaciones potencialmente mortales como la mediastinitis necrotizante descendente (MND). La MDN es una infección grave que afecta al cuello-tórax, con una alta tasa de mortalidad por sepsis e insuficiencia orgánica si no se trata de manera rápida y efectiva. Objetivo: Describir un caso de MND de origen odontogénico y su manejo médico-quirúrgico. Caso clínico: Presentamos un paciente de sexo masculino de 34 años que ingresa con un cuadro infeccioso agudo de origen odontogénico, que compromete espacios de la cabeza, cuello y tórax (mediastino superior), el cual se trata exitosamente. Discusión: Las infecciones odontogénicas son generalmente localizadas y que se pueden tratar mediante terapias convencionales. A pesar de esto, si estas infecciones no pueden controlarse, ya sea por no realización de tratamientos oportunos o por estados inmunosuprimidos del paciente, se pueden desarrollar diferentes complicaciones como la MND. Conclusión: Un diagnóstico rápido, el tratamiento quirúrgico agresivo, la terapia antibiótica adecuada y la atención de apoyo son los pilares fundamentales para el manejo de la MND.

Introduction: Inappropriate and ineffective treatment of odontogenic infections can cause life-threatening complications such as Descending Necrotizing Mediastinitis (MND). MDN is a serious infection that affects the neck-thorax, with a high mortality rate from sepsis and organ failure if it is not treated quickly and effectively. Aim: To describe a case of MND of odontogenic origin and its medical-surgical management. Case report: We present a 34-year-old male patient who is admitted with an acute infectious condition of odontogenic origin, which compromises spaces of the head, neck and thorax (upper mediastinum), which is treated successfully. Discussion: Odontogenic infections are generally localized and can be treated by conventional therapies. In spite of this, if these infections cannot be controlled, either by not carrying out appropriate treatments or by immunosuppressed states of the patient, different complications such as MND can develop. Conclusion: A rapid diagnosis, aggressive surgical treatment, adequate antibiotic therapy and supportive care are the fundamental pillars for the management of MND.

[Basis for the multidisciplinary approach to shoulder pseudoparesis and pseudoparalysis due to rotator cuff pathology]. / Bases para el abordaje multidisciplinario de la seudo paresia y seudo parálisis de hombro por patología del manguito rotador.

INTRODUCTION: The painful shoulder is an entity that generates much of the orthopedic consultations worldwide, although it can affect at any stage of life, its prevalence is higher as age increases. Rotator cuff condition is often the most relevant cause of pain and dysfunction. Two common consequences of rotator cuff condition are pseudoparesis and pseudoparalysis, and even though they share similar etiology and symptomatology, their clinical differentiation is critical for optimal management and timely resolution. OBJECTIVE: To review the theoretical and clinical bases for the differentiation and management of pseudoparesis and pseudoparalysis due to rotator cuff pathology. MATERIAL AND METHODS: Descriptive review of the concepts of pseudoparesis and pseudoparalysis from the orthopedic, physiotherapy and rehabilitation perspective. RESULTS: Once the differences in rotator cuff injury mechanisms and how they translate into painful shoulder semiology are understood, it is possible to integrate a differential diagnosis between pseudoparesia and pseudoparalysis. Diagnosis should integrate specific evaluations and exercises to identify both conditions and, once distinguished and identified, allow optimal guidance of therapeutic approach. CONCLUSION: The differentiation between pseudoparalysis and pseudoparesis allows us to understand the mechanisms of injury and, finally, to provide the optimal treatment for patients with painful shoulder due to rotator cuff pathology.

INTRODUCCIÓN: El hombro doloroso es una entidad que genera gran parte de las consultas de ortopedia a nivel mundial, si bien puede afectar en cualquier etapa de la vida, su prevalencia es mayor conforme aumenta la edad. La afección del manguito rotador suele ser la causa más relevante de dolor y disfunción. Dos consecuencias comunes de la afección del manguito rotador son la seudo paresia y la seudo parálisis y aun cuando comparten una etiología y sintomatología semejantes, su diferenciación clínica es fundamental para su manejo óptimo y resolución oportuna. OBJETIVO: Revisar las bases teóricas y clínicas para la diferenciación y manejo de la seudo paresia y seudo parálisis por patología del manguito rotador. MATERIAL Y MÉTODOS: Revisión descriptiva de los conceptos de seudo paresia y seudo parálisis desde la perspectiva ortopédica, de fisioterapia y rehabilitación. RESULTADOS: Una vez que se comprenden las diferencias en los mecanismos de lesión del manguito rotador y el modo en el que se traducen en la semiología del hombro doloroso, es posible integrar un diagnóstico diferencial entre seudo paresia y seudo parálisis. El diagnóstico debe integrar las evaluaciones y ejercicios específicos para que permitan identificar ambas condiciones y, una vez que se han distinguido e identificado, permitirá orientar el abordaje terapéutico de manera óptima. CONCLUSIÓN: La diferenciación entre seudo parálisis y seudo paresia permite comprender los mecanismos de lesión y, finalmente, proporcionar el tratamiento óptimo a los pacientes con hombro doloroso por patología del manguito rotador.

[Main causes of orthopedic external consultation in a Second Level Clinic in Mexico]. / Principales motivos de consulta externa ortopédica en un hospital de segundo nivel en México.

INTRODUCTION: The epidemiology of diseases allows the generation of preventive measures, for the modification of their natural evolution or to prevent their appearance. In second-level hospitals of care, most of the pathologies of each medical specialty are treated. Therefore, knowing the main reasons for external consultation in orthopedics and their seasonal predominance is a tool for implementing strategies for the benefit of patients. MATERIAL AND METHODS: Observational study carried out with the patient population of the external orthopedic consultation service of a second-level hospital of care, from January to December 2017. Patients over the age of 18 who first attended consultation were included. RESULTS: 11,704 consultations granted in the period, 7,862 (67.17%) women and 3,842 (32.82%) men. The average age of patients was 51.84 ± 0.14. The most common cause of consultation was arthropathies (47.65%). During the autumn, the largest number of consultations (32.33) were granted. CONCLUSIONS: Arthropathies, specifically gonarthrosis, were the main reason for external consultation, accounting for nearly half of the consultations granted. It is transcendental to identify the modifiable risk factors of these pathologies with the aim of reducing the negative impact it generates at the functional, economic and quality of life level. Clinical relevance: Further epidemiological studies on orthopedic pathologies will improve preventive strategies and optimize resources to improve patient care.

INTRODUCCIÓN: La epidemiología de las enfermedades permite la generación de medidas preventivas para la modificación de su evolución natural o para evitar su aparición. En los hospitales de segundo nivel de atención se tratan la mayor parte de las patologías de cada especialidad médica. Por lo tanto, saber los principales motivos de consulta externa en ortopedia y su predominio estacional es una herramienta para la implementación de estrategias en beneficio de los pacientes. MATERIAL Y MÉTODOS: Estudio observacional realizado con la población de pacientes del servicio de consulta externa de ortopedia de un hospital de segundo nivel de atención de Enero a Diciembre del año 2017. Se incluyeron pacientes mayores de 18 años que acudieron a consulta por primera vez. RESULTADOS: De 11,704 consultas otorgadas en el período, 7,862 (67.17%) fueron mujeres y 3,842 (32.82%) hombres. La edad promedio de los pacientes fue de 51.84 ± 0.14. La causa más frecuente de consulta fueron las artropatías (47.65%). Durante el otoño se otorgó el mayor número de consultas (32.33%). CONCLUSIONES: Las artropatías, específicamente la gonartrosis, fue el principal motivo de consulta externa, representando casi la mitad de las consultas otorgadas. Es transcendental identificar los factores de riesgo modificables de estas patologías con el objetivo de disminuir el impacto negativo que genera a nivel funcional, económico y de calidad de vida. Importancia clínica: La realización de más estudios epidemiológicos sobre las patologías ortopédicas permitirá mejorar las estrategias preventivas y optimizar los recursos para mejorar la atención de los pacientes.

Determining of risk areas due to exposure to heavy metals in the Toluca Valley using epiphytic mosses as a biomonitor.

The work aim is to identify the risk areas by exposure to Cr, Cu, Pb and Zn in the Metropolitan Zone of Toluca Valley (MZTV) using the mosses Fabriona cilaris and Leskea angustata as a biomonitors, geostatistical interpolation and multi-criteria evaluation by analytical hierarchy process. The results from the estimation of the enrichment factors (EF) showed that Pb is the heavy metal with the highest values, followed by the Zn, Cu and Cr. The EF obtained for all heavy metals show that there is a moderate to high anthropogenic enrichment. The above indicates that in the MZTV there are emission sources that contribute (significantly) in the amount of Cr, Cu, Pb and Zn accumulated in the biomonitor. Combustion processes, vehicle emissions, biomass burning, brick kiln emissions, agricultural and livestock activities, manufacturing industry and re-deposition by the action of the wind, were identified as the main heavy metals sources in the MZTV. Risk maps showed the high and medium risk areas are located in sites with poor urban vegetation coverage and close to highways and industrial parks. Low risk areas are located in sites with high urban vegetation coverage. The method used for identifying risk areas is a rapid and low-cost evaluation tool can allow local government environmental agencies to define public policies on air pollution control.

Susceptibilidad antimicrobiana en muestras urogenitales de ureaplasma urealyticum, el principal agente en infección intramaniótica / Antimicrobial susceptibility in urogenital samples of ureaplasma urealyticum, the main agent in intramaniotic infection

RESUMEN OBJETIVO: Ureaplasma urealyticum es el agente más frecuentemente aislado en infección intraamniótica. Los macrólidos son los antimicrobianos de primera elección en embarazadas. Se ha descrito el aumento de resistencia, pudiendo limitar las opciones terapéuticas durante la gestación. El propósito del estudio es evaluar susceptibilidad antimicrobiana de Ureaplasma urealyticum aislado en mujeres en edad fértil, que se atienden en Clínica Alemana Temuco, Araucanía, Chile. METODO: Se estudian todas las muestras de orina y flujo vaginal para cultivo de U. urealyticum, de pacientes entre 18 y 40 años, recibidas en el Laboratorio de Microbiología Clínica Alemana Temuco, en período Abril 2013 a Enero 2015. Se procesan las muestras con kit Mycoplasma IST 2 de Biomerieux. En las que resultan positivas, se estudia susceptibilidad a macrólidos, tetraciclinas y quinolonas. RESULTADOS: 426 muestras de orina y flujo vaginal (390 pacientes). 197 pacientes resultaron positivas para U. urealyticum. (50,5%). La susceptibilidad fue 88,4% (174 pctes) a Eritromicina, 87,9% (173 pctes) a Claritromicina y 91,9% (181 pctes) a Azitromicina (NS). 15 de 197 pacientes (7,6%) fueron resistentes a los 3 macrólidos. La susceptibilidad a Quinolonas fue 55,3% a Ciprofloxacino, y 94% a Ofloxacino. El 100% resultó susceptible a Tetraciclinas. CONCLUSIONES: Cerca del 10% de U. urealyticum aislados en nuestra serie son resistentes a macrólidos, contribuyendo a la no erradicación de la infección en tratamientos empíricos. Dentro de ellos, azitromicina aparece con la mayor efectividad. El aumento de resistencia limitará opciones terapéuticas, con gran impacto perinatal en futuro. La vigilancia de susceptibilidad en cada hospital es fundamental para elección terapéutica.

ABSTRACT INTRODUCTION: Ureaplasma urealyticum is the most frequently isolated microorganism in intra-amniotic infection. The macrolides are the first choice antimicrobials for treat this infection in pregnancy. The increasing resistance has been described worldwide, seriously limiting therapeutic options in pregnancy. The aim of the study is to evaluate antimicrobial susceptibility of U. urealyticum aislated in fertile-age women in Clínica Alemana Temuco, Araucania region, Chile. METHOD: Urine and vaginal samples were analyzed for U. urealyticum, from every 18 to 40 years old patients, received at Microbiology Laboratory of Clínica Alemana Temuco, between April 2013 to January 2015. The samples are processed with Mycoplasma IST 2 kit of Biomerieux. If they became positives, susceptibility to macrolides, tetracyclines and quinolones was studied. RESULTS: 426 urine and vaginal samples were collected (390 patients). 197 patients were positive for U. urealyticum (50.5%). The susceptibility was 88.4% (174 pts) to Erythromicyn, 87.9% (173 pts) to Clarithromycin and 91.9% (181 pts) to Azithromycin (NS). Resistance to all macrolides was observed in 15 out of 197 patients (7.6%). The susceptibility to Quinolones was 55.3% to Ciprofloxacin, and 94% to Ofloxacin. The 100% was susceptible to Tetracyclines. DISCUSSION: Near to 10% of isolated Ureaplasma spp in our serie were resistant to some macrolide, being a factor for failing to eradicate the infection in empirical treatment. Azithromycin was the most effective. The increasing resistance will limit therapeutic options, with great perinatal impact in the future. Susceptibility surveillance in each hospital is very important for therapeutic options.

Simultaneous TAPP inguinal repair and laparoscopic cholecystectomy: results of a case series.

BACKGROUND: Cholecystectomy and inguinal hernioplasty are the most frequent surgeries in Chile and the world. Laparoscopic inguinal hernioplasty, being a clean surgery, reports mesh infection rates of less than 2% and adding a simultaneous laparoscopic cholecystectomy is controversial due to an increase in the risk of mesh infection. The aim of this paper is to report the results of simultaneous TAPP hernioplasty with laparoscopic cholecystectomy. METHOD: Retrospective analysis of the digestive surgery database. We identified cases in which laparoscopic inguinal TAPP repair and simultaneous laparoscopic cholecystectomy were performed. Demographic, clinical information, hernia type and size, data from the surgery and its complications were also retrieved and analyzed. RESULTS: We identified 21 patients, 86% male and with an average age of 61 years range 46-84. 72% of the hernias were unilateral, predominating indirect 50%, direct 28% and the remaining were femoral and mixed. The average hernia size was 2.2 cm. The meshes used were 56% polypropylene, 37% polyester and 5% PVDF. We report one gallblader perforation. At a median time of 40 months of follow-up (range 4-89 months), one hernia recurrence was found (3.7%), there were no reoperations at the time of the interview and there were no cases of mesh infection. Complications of surgery includes one ipsilateral testicular atrophy 4.8% and 1 ipsilateral inguinal seroma 4.8%. CONCLUSIONS: In this series of cases, adding clean contaminated surgery to the inguinal TAPP hernioplasty was not associated with an increase in the infection of the mesh.

[Posterior instability of the shoulder]. / Inestabilidad posterior del hombro.

No Abstract available.

Riesgo de trastorno de la conducta alimentaria en adolescentes chilenos de diferentes tipos de establecimientos educacionales / Risk of eating disorders in Chilean adolescents of different types educational establishments

Los trastornos de la conducta alimentaria (TCA) son patologías de salud mental complejas, caracterizados por una alteración persistente del comer o del comportamiento relacionado con la alimentación. El objetivo de este estudio fue determinar el riesgo de TCA en adolescentes de diferentes tipos de establecimientos educacionales de la ciudad de Concepción, Chile. La muestra fue constituida por estudiantes de 7mo año básico a 4to año de enseñanza media, cuyo rango de edad fue de 13 a 18 años, pertenecientes a establecimientos educacionales municipalizados, particular subvencionados y particular, de la ciudad de Concepción. Para determinar riesgo de TCA, se empleó el instrumento de Test de Actitudes Alimentarias (EAT-40), junto a ello se realizaron mediciones de peso y talla para calcular el Índice de Masa Corporal. La muestra final comprendió 1056 estudiantes, de los cuales 37,5% eran hombres y 62,5% eran mujeres. El riesgo de desarrollar un TAC fue de 16,1%, siendo mayor en mujeres (21,8%) en relación con los hombres (6,6%) (p<0.001). Se evidenció mayor riesgo de TCA en mujeres con estado nutricional con sobrepeso (27,7%) y en hombres con estado nutricional de obesidad (14,7%). Al evaluar riesgo de TCA por tipo de establecimientos educacionales, se observan diferencias, pero sin resultados significativos (p 0,2008). Es relevante contar con políticas públicas que permitan abordar y acompañar a los adolescentes en riesgo de desarrollar un TCA(AU)

Eating disorders are complex mental health illnesses, characterized by irregular eating habits or behavior related to food. The purpose of this study was to determine the risk of eating disorders in adolescents from different educational establishments in the city of Concepción. The sample was constituted by students of seventh grade of basic education to fourth year of secondary, whose age range was from 13 to 18, belonging to public, subsidized and private educational establishments in the city of Concepción. To determine the risk of eating disorder, the Eating Attitudes (EAT-40) was used, and weight and height were measured to calculate body mass index. The final sample was composed of 1056 students, of which 37,5% were men and 62,5% women. The risk of developing an eating disorder was 16,1%, being higher in women (21,8%) in relation to men (6,6%) (p <0,001). It was demonstrated a higher risk of TCA in overweight women (27, 7%) and men with obesity (14, 7%). In assessing risks of TCA per type of educational establishments there were some differences but without significant results (p 0, 2008). It is essential to have public policies that allow the approach and accompany adolescents at risk of developing a disorder of eating behavior(AU)

Concentraciones de Vitamina D en niños y adolescentes con enfermedad celíaca / Vitamin D concentrations in children and adolescents with celiac disease

INTRODUCCIÓN: En celíacos la ingesta de gluten provoca una lesión inflamatoria de origen autoinmune que causa un daño progresivo de las vellosidades del intestino delgado, comprometiendo la absorción de nutrientes y posible daño a otros órganos. OBJETIVO: Determinar las concentraciones plasmáticas de 25-hidroxivitamina D (25OHD) en niños y adolescentes chilenos con enfermedad celíaca. PACIENTES Y MÉTODO: Estudio descriptivo de corte transversal. Participaron 16 pacientes pediátricos de ambos sexos, diagnosticados con enfermedad celíaca. Se determinó antecedentes ge nerales, estado nutricional y parámetros bioquímicos. Las concentraciones plasmáticas de 25OHD se clasificaron como suficientes cuando estaban entre 30-100 ng/ml, insuficiente (20-29 ng/ml) y deficiente (< 20 ng/ml). RESULTADOS: La edad de los pacientes estaba comprendida entre 5 y 18 edad (edad: 11 ± 4 años). De los participantes 4 de 16 presentaron concentraciones normales de 25OHD, 8 insuficiente y 1 deficiente. Según IMC, 11 tenían estado nutricional normal, 4 sobrepeso y 1 obesidad. El diagnóstico de la talla mostró 7 de 16 casos de talla baja y normal baja. Al relacionar las concentraciones de 25OHD con estado nutricional, los parámetros deficientes e insuficientes se concentraron en 9 pacientes con estado nutricional normal, 2 con sobrepeso y 1 con obesidad. Se realizaron asociaciones entre las concentraciones de 25OHD y todas las variables estudiadas y no se encontró ninguna asociación significativa. CONCLUSIÓN: Se encontró una alta frecuencia de insuficiencia y deficiencia de 25OHD en el grupo de niños y adolescentes chilenos con enfermedad celíaca.

INTRODUCTION: In children with celiac disease, gluten intake causes an autoimmune, inflammatory and progressive lesion of the small intestine villi, compromising the absorption of nutrients and pos sible damage to others organs. OBJECTIVE: To determine plasma 25-hydroxyvitamin D [25(OH)D] concentrations in Chilean child and adolescents with celiac disease. PATIENTS AND METHOD: A descriptive cross-sectional study was carried out in which 16 pediatric patients of both genders diagnosed with celiac disease participated. General background, nutritional status and biochemical parameters were determined. Plasma 25(OH)D concentrations were classified as sufficient between 30-100 ng/ ml, insufficient between 20-30 ng/ml and deficient as <20 ng/ml. RESULTS: The age of the patients was between 5 and 18 years (age: 11 ± 4 years). Four out of 16 participants had normal 25(OH)D concentrations, eight had insufficient concentrations and one had deficient concentrations. Accor ding to BMI, 11 patients had normal nutritional status, four were overweight and one was obese. In relation to height, seven out of 16 cases presented short stature and normal-low height. Associating 25(OH)D concentrations to nutritional status, nine patients with normal nutritional status, two with overweight and one with obesity presented deficient and insufficient parameters. No significant asso ciations were found between 25(OH)D concentrations and all studied variables. CONCLUSION: A high frequency of insufficiency and deficiency of 25(OH)D was found in the group of Chilean children and adolescents with celiac disease.

The use of female estrogenized goats as sexual stimulator of crossbred dairy males subsequently exposed to acyclic goats during two phases of the anestrous season.

This research evaluated the possible influence of exposure of male goats to estrogenized female goats ("female effect") upon males' sexual behavior [appetitive (ASB) & consummatory (CSB)], as well as the induction of reproductive activity of crossbred dairy female goats exposed to such treated males ("male effect") during the early and deep anestrous periods. Crossbred dairy adult male goats (n = 12; 24-48 mo. old) and 80 anovulatory crossbred dairy adult female goats (34-50 mo. old) were used during two experimental periods: March to April and April to May. First, males were separated into four groups (n = 3 each), roughly homogeneous regarding body weight and body condition score and randomly assigned to four experimental groups. The first two groups included males + estrogenized females, then such males were exposed to anestrous females either during March (group 1: three males; 20 females; EFEM-MAR), or during April (group 2: three males; 20 females; EFEM-APR). The second two groups were respective control groups: Males + non-treated-anestrous females, and then such males exposed to acyclic females either during March (group 3: three males; 20 females; CONT-MAR) or April (group 4: three males; 20 females; CONT-APR). Once the male-to-female contact was established, both odor (ODT) and behavior (BEHT) tests (2 d × 2 h) were performed during both anestrous periods. On day 10 after introduction of the males, in both anestrous periods, one ultrasonography scanning ("US") was performed to quantify the presence, number and size of corpus luteum (US-CL) to determine the effectiveness of the "male effect" and indicators of ovarian activity. Then, on day 45 after introduction of the males, a second US was performed to evaluate pregnancy rate (US-PREG). The EFEM-males, regardless of the phase of the anestrous cycle, had an increased (P < 0.05) odor intensity with respect to the control groups. In addition, while an increased (P < 0.05) ASB occurred in the EFEM-males, no CSB differences (P > 0.05) arose when treatments were compared, neither in March-April nor in April-May. The EFEM-males exposed to acyclic goats in March-April (i.e. early anestrous period), promoted not only the largest estrus and ovulatory responses (P < 0.05), but also the largest pregnancy rate (P < 0.05) in these previously anestrus goats, suggesting that in April-May (i.e. profound anestrous), the presence of active males was not enough to completely suppress cyclic reproductive arrest. This study generates interesting out-of-season reproductive outcomes in a goat population with a large proportion of highly seasonal dairy breeds (i.e. Alpine, Saanen and Toggenburg), augmenting the possibility to expand milk production and the economic income of goat producers across the year. Besides, this practice may serve as an interesting reproductive tool to increase the sustainability of marginal goat production systems under semiarid conditions.

¿Es seguro y efectivo tratar la apendicitis aguda no complicada con antibióticos?- Primera actualización / Are antibiotics a safe and effective treatment for acute uncomplicated appendicitis?- First update

ACTUALIZACIÓN: Este resumen Epistemonikos (Living FRISBEE: Living FRIendly Summary of the Body of Evidence using Epistemonikos) es una actualización del resumen publicado en enero de 2016. INTRODUCCIÓN: La apendicitis es una causa típica de dolor abdominal agudo y la causa más frecuente de cirugía abdominal de urgencia. En las últimas dos décadas se ha publicado creciente evidencia sobre el uso de antibióticos como tratamiento exclusivo de la apendicitis aguda. MÉTODOS: Para responder esta pregunta utilizamos Epistemonikos, la mayor base de datos de revisiones sistemáticas en salud, la cual es mantenida mediante búsquedas en múltiples fuentes de información, incluyendo MEDLINE, EMBASE, Cochrane, entre otras. Extrajimos los datos desde las revisiones identificadas, reanalizamos los datos de los estudios primarios, realizamos un metanálisis y preparamos una tabla de resumen de los resultados utilizando el método GRADE. RESULTADOS Y CONCLUSIONES: Identificamos 23 revisiones sistemáticas que en conjunto incluyeron 28 estudios primarios, de los cuales ocho corresponden a ensayos aleatorizados. Concluimos que el uso exclusivo de antibióticos para el tratamiento de la apendicitis aguda no complicada podría ser menos efectivo que la apendicectomía y asociarse a una mayor estadía hospitalaria, pero por otro lado podría asociarse a una menor tasa de complicaciones.

UPDATE: This Living FRISBEE (Living FRIendly Summary of the Body of Evidence using Epistemonikos) is an update of the summary published in January 2016. INTRODUCTION: Appendicitis is a typical cause of acute abdominal pain and the most frequent cause of emergency abdominal surgery. In the last two decades, increasing evidence has been published about the use of antibiotics as an exclusive treatment for acute appendicitis. METHODS: To answer this question, we used Epistemonikos, the largest database of systematic reviews in health, which is maintained through searches from multiple sources of information, including MEDLINE, EMBASE, Cochrane, among others. We extracted the data from the identified reviews, reanalyzed the data from the primary studies, performed a meta-analysis and prepared a summary of findings table using the GRADE approach. RESULTS AND CONCLUSIONS: We identified 23 systematic reviews including 28 primary studies, of which eight were randomized trials. We concluded the exclusive use of antibiotics for the treatment of uncomplicated acute appendicitis could be less effective than appendectomy, but it might be associated with a lower rate of complications.

Apendicectomía laparoscópica versus cirugía abierta para la apendicitis complicada / Laparoscopic versus open appendectomy for complicated appendicitis

INTRODUCCIÓN El tratamiento de la apendicitis aguda por vía laparoscópica reduce el riesgo de infección de la herida operatoria, disminuye el tiempo de hospitalización y acelera el retorno a las actividades. Sin embargo, aumenta el riesgo de infecciones intraabdominales, lo cual constituye uno de las principales riesgos del tratamiento quirúrgico laparoscópico de la apendicitis complicada. MÉTODOS Realizamos una búsqueda en Epistemonikos, la mayor base de datos de revisiones sistemáticas en salud, la cual es mantenida mediante el cribado de múltiples fuentes de información, incluyendo MEDLINE, EMBASE, Cochrane, entre otras. Extrajimos los datos desde las revisiones identificadas, analizamos los datos de los estudios primarios, realizamos un metanálisis y preparamos una tabla de resumen de los resultados utilizando el método GRADE. RESULTADOS Y CONCLUSIONES Identificamos seis revisiones sistemáticas que en conjunto incluyen 55 estudios primarios, de los cuales, cuatro corresponden a ensayos aleatorizados. Concluimos que la laparoscopía, en comparación con la cirugía abierta, probablemente disminuye el tiempo de estadía hospitalaria, y podría disminuir el riesgo de infección de la herida operatoria, pero no está claro si existen diferencias en la incidencia de absceso intraabdominal porque la certeza de la evidencia es muy baja.

INTRODUCTION The treatment of acute appendicitis using laparoscopy reduces the risk of wound infection, hospitalization time and return to normal activity. However, it increases the risk of intra-abdominal abscess, which is one the main complications of complicated appendicitis. METHODS We searched in Epistemonikos, the largest database of systematic reviews in health, which is maintained by screening multiple information sources, including MEDLINE, EMBASE, Cochrane, among others. We extracted data from the systematic reviews, reanalyzed data of primary studies, conducted a meta-analysis and generated a summary of findings table using the GRADE approach. RESULTS AND CONCLUSIONS We identified six systematic reviews including 55 studies overall, of which four were randomized trials. We concluded that the used of laparoscopy, compared to open appendectomy, probably reduces the time of hospital stay, and may reduce the risk of wound infection, but there's no clarity regarding the incidence of intra-abdominal abscess due to the very low certainty of the evidence available.

Tuberculosis diseminada de médula ósea en pacientes VIH etapa SIDA. Reporte de 2 casos / Disseminated bone marrow tuberculosis in aids stage hiv (+) patients. 2 case reports

La tuberculosis extrapulmonar se define como tuberculosis que involucra a un órgano diferente al pulmón. Ocurre secundario a una diseminación de un foco pulmonar, la cual se favorece en estados de inmunosupresión, como es en el caso de pacientes portadores de VIH. Dentro de las localizaciones menos frecuentes, se encuentra la médula ósea. En la actualidad no existen reportes de casos de esta forma de tuberculosis extrapulmonar en pacientes VIH. En este artículo reportamos dos casos de pacientes con VIH etapa SIDA con diseminación en médula ósea. Este reporte destaca la importancia de tener presente esta complicación y realizar un estudio amplio, que incluya cultivo de Koch y tinción de Ziehl Nielsen de las muestras obtenidas, especialmente en este tipo de pacientes que pueden presentar clínica pobre e inespecífica.

Extra-pulmonary tuberculosis is defined to be tuberculosis involving any organ other than the lung. Immune suppressed states such as being HIV (+) favor dissemination from pulmonary foci. Bone marrow is one of the least frequent locations. At present there are no recorded cases of this form of extra-pulmonary tuberculosis in HIV (+) patients. We present two cases of HIV (+) patients in the AIDS stage with bone marrow dissemination. This reports underlines the importance of considering this complication and doing a comprehensive study, including testing samples using Koch culture and Ziehl Nielsen stains, especially in patients with few and non-specific clinical signs.

Artroplastía total de hombro bajo monitoreo de la perfusión cerebral. Reporte del primer caso en México / Total shoulder arthroplasty under monitoring of cerebral perfusion. Report of the first case in Mexico

Resumen: Introducción: Desde hace algún tiempo es tema de controversia el mantenimiento de la perfusión cerebral durante la cirugía de hombro realizada en posición de silla de playa. El objetivo de este reporte es presentar el primer caso en México de una artroplastía total de hombro realizada con bloqueo interescalénico y monitoreo de la saturación cerebral de oxígeno. Este monitoreo se describió en 1977, pero sólo hasta la última década ha alcanzado relevancia desde el punto de vista clínico. Caso clínico: Paciente de 84 años programado para artroplastía total de hombro en posición de silla de playa bajo anestesia regional tipo bloqueo interescalénico guiado por ultrasonido, en la cual se monitoreó la saturación regional de oxígeno (CrSO2). Discusión: El monitoreo de la oximetría cerebral es una herramienta adecuada que nos permite tener una valoración continua durante todo el transanestésico, con lo que podemos tomar decisiones de forma más expedita. Con base en esto consideramos que este tipo de monitoreo debe ser básico en pacientes colocados en posición de silla de playa, así como el uso preponderante de anestesia regional; en los casos donde ésta no se pueda utilizar, este monitor es primordial.

Abstract: Introduction: The maintenance of cerebral perfusion during shoulder surgery performed in the beach chair position is controversial. The aim of this report is to present the first case in Mexico of a total shoulder arthroplasty performed with interscalene block and monitoring of the cerebral oxygen saturation. This monitoring was described in 1977, but only until the last decade has it reached relevance from the clinical point of view. Clinical case: We present an 84-year-old patient scheduled for total shoulder arthroplasty in beach chair position under regional anesthesia (ultrasound-guided interscalene block) in which the regional oxygen saturation (CrSO2) was monitored. Discussion: Monitoring of cerebral oximetry is a suitable tool that allows us to have a continuous assessment throughout the transanesthetic, so we can make decisions more expeditiously. On this basis, we believe that this type of monitoring should be fundamental in patients placed in a beach chair position, as well as predominantly use regional anesthesia. In cases where it cannot be used, this monitor is absolutely essential.

Combined antibacterial/tissue regeneration response in thermal burns promoted by functional chitosan/silver nanocomposites.

We report the combined antibacterial/tissue regeneration responses to thermal burns promoted by functional chitosan/silver nanocomposites (CS/nAg) with ultralow silver content (0.018wt.%, 7-30nm). Our approach allows one to produce CS/nAg nanocomposites without silver nanoparticles (nAg) agglomeration, with bactericide potency higher than 1wt.% of nAg (ca. 10nm) content and, promoting the healing process in controlled thermal burns. CS/nAg films exhibit high antibacterial activity against S. aureus and P. aeruginosa after 1.5h of incubation, demonstrating the bacterial penetration into hydrated films and their interaction with nAg. Additionally, exceptional healing of induced thermal burns was obtained by increasing myofibroblasts, collagen remodeling, and blood vessel neoformation. These factors are associated with epiderma regeneration after 7days of treatment with no nAg release. Our results corroborate the controlled synthesis of nAg embedded in CS matrix with combined antibacterial/biocompatibility properties aiming to produce functional nanocomposites with potential use in wound dressing and health care applications.